Healthcare Provider Details

I. General information

NPI: 1306224662
Provider Name (Legal Business Name): J & R PHARMACY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MAGNOLIA AVE STE 1G
CORONA CA
92879-3121
US

IV. Provider business mailing address

770 MAGNOLIA AVE STE 1-G
CORONA CA
92879-3120
US

V. Phone/Fax

Practice location:
  • Phone: 951-531-8041
  • Fax: 951-531-8043
Mailing address:
  • Phone: 951-531-8041
  • Fax: 951-531-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY55570
License Number StateCA

VIII. Authorized Official

Name: JACQUELINE IBRAHIM
Title or Position: CEO/PIC
Credential: RPH
Phone: 951-531-8041